Autologous Fat Grafting as a Stand-alone Method for Immediate Breast Reconstruction After Radical Mastectomy in a Series of 15 Patients

Abstract

Objective: To date, breast reconstruction after mastectomy essentially uses flapor prosthetic-based surgery. Autologous fat grafting (AFT) largely used in breast conservative surgery is considered an additional technique in breast reconstruction. The aim of this retrospective study was to report our experience of AFT as a stand-alone method for immediate breast reconstruction. Patients and Methods: Fifteen patients requiring a radical mastectomy underwent AFT for immediate reconstruction since 2014. Previous breast irradiation was not a contraindication. Procedures, complications, and cosmetic results were retrospectively analyzed. Results: Fifteen patients with an average age of 60.5 (43-78) years were included in this retrospective study. They had a body mass index ranging from 19 to 40. Fourteen had a mastectomy for cancer and 1 for prophylaxis. Nine received breast irradiation (7 before surgery and 2 adjuvant). A mean of 3 (2-6) AFT procedures were required to achieve total breast reconstruction. Except for the first transfer, others were performed as outpatient surgeries. Only 2 minor complications (1 hematoma and 1 abscess) not impairing results were reported. The results after a mean follow-up of 26 months were considered by the patients and surgeon as highly satisfactory even in previously irradiated breast, as assessed using a qualitative scoring analysis. Conclusions: Autologous fat grafting as a stand-alone method for immediate breast reconstruction after radical mastectomy is a safe procedure with very consistent results even for patients requiring radiation therapy.

Autologous Fat Grafting as a Stand-Alone Procedure for Post-Mastectomy Breast Reconstruction and the Potential for Improvement using Adipose-Derived Stem Cells

“…However, ABR is a large-scale procedure with significant risks such as flap necrosis, donor site morbidity, and aesthetic concerns due to the scarring. ABR also needs a surgeon's microsurgical skills to perform the microanastomosis between the vessels responsible for the flap's viability [9]. The limitations of both procedures and the fact that surgery is moving towards a less invasive era [10] are a call toward a novel technique for breast reconstruction such as autologous fat grafting (AFG).…”

“…Several authors [9,11,12] consider AFG as an easy, quick and safe procedure. AFG is the transfer of adipose tissue (fat) from a donor site of the patient's body to the chest to reconstruct the breast in a series of minimally invasive procedures [13].…”

“…It is radiologically safe as patients often undergo post-mastectomy radiotherapy. It also offers a natural feel, it is technically easier, with a shorter recovery time and lower complication rates [9,11,13]. Authors also consider AFG as a more cost-effective technique compared to other reconstruction methods [11,15].…”

“…However, the literature lacks a more critical view of the studies reporting patient outcomes after a stand-alone AFG procedure. For this reason, the following section will discuss four studies [9,12,18,19] published between 2019 to 2022 that base their results on patient-reported outcomes after standalone AFG for breast reconstruction. Studies using AFG for full breast augmentation for non-breast cancer patients are not discussed.…”

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

“…Autologous fat grafting (AFG) where fat cells are harvested with liposuction, prepared, and then injected into the body is commonly utilized as an adjunct to enhance cosmetic and functional outcomes in breast reconstruction [ 36 ]. AFG as a stand-alone procedure for breast reconstruction is in its infancy but there is emerging data to support this technique [ 37 ]. AFG can sometimes be associated with unwanted effects such a fat necrosis and oil cyst development which can impact cosmesis in terms of texture, breast contour, and abnormalities on subsequent breast imaging [ 38 , 39 ].…”